SEARNEST
New
I would really appreciate an expert opinion on the following case:
A micropuncture needle was used to puncture the right femoral artery. A 5 French sheath was placed. A pigtail catheter was then positioned in the aortic arch. Arch angiogram revealed a normal-appearing arch with no stenosis at the origin of the innominate or left common carotid. The left subclavian origin was patent. The stent appeared patent, but there was critical narrowing with apparent chronic dissection just beyond the stent with the remainder of the subclavian artery patent. The vertebral artery is not seen on this projection. The left sublcavian was then selectively catheterized, and angiogram confirmed placement of the catheter in the stent and lumen, and a wire was passed into the distal subclavian artery. A long 5-French sheathe was then placed right up to the subclavian stenosis. The patient was given 4,000 units of Heparin IV. A 4 and then a 5-mm ballon angioplasty was performed. Afterh the 4-mm angioplasty, the stent was opened, and there was flow into the vertebral artery, but there was significant residual stenosis. A 5 French balloon angioplasty was then performed which opened up the origin of the stent a little better, and there was good flow distally, but now the vertebral artery was again not seen, and I believe that the dissection was right at the vertebral artery level. At this point, I did not feelthere was a need to place a stent and the patient would likely need a left carotid subclavian bypass. A right femoral angiogram confirmed placement of the catheter in the common femoral artery and a 6 French Angio-Seal was placed without difficulty.
I would like to code as: 36215, 35475, 75710-2659, 75605-2659, 75962-26
My logic is that he performed the angiogram from the aorta, not the subclavian. I also considered code 36221, but did not feel the documentation met those requirements.
Thank you in advance for your time.
Sandra Earnest, CPC
A micropuncture needle was used to puncture the right femoral artery. A 5 French sheath was placed. A pigtail catheter was then positioned in the aortic arch. Arch angiogram revealed a normal-appearing arch with no stenosis at the origin of the innominate or left common carotid. The left subclavian origin was patent. The stent appeared patent, but there was critical narrowing with apparent chronic dissection just beyond the stent with the remainder of the subclavian artery patent. The vertebral artery is not seen on this projection. The left sublcavian was then selectively catheterized, and angiogram confirmed placement of the catheter in the stent and lumen, and a wire was passed into the distal subclavian artery. A long 5-French sheathe was then placed right up to the subclavian stenosis. The patient was given 4,000 units of Heparin IV. A 4 and then a 5-mm ballon angioplasty was performed. Afterh the 4-mm angioplasty, the stent was opened, and there was flow into the vertebral artery, but there was significant residual stenosis. A 5 French balloon angioplasty was then performed which opened up the origin of the stent a little better, and there was good flow distally, but now the vertebral artery was again not seen, and I believe that the dissection was right at the vertebral artery level. At this point, I did not feelthere was a need to place a stent and the patient would likely need a left carotid subclavian bypass. A right femoral angiogram confirmed placement of the catheter in the common femoral artery and a 6 French Angio-Seal was placed without difficulty.
I would like to code as: 36215, 35475, 75710-2659, 75605-2659, 75962-26
My logic is that he performed the angiogram from the aorta, not the subclavian. I also considered code 36221, but did not feel the documentation met those requirements.
Thank you in advance for your time.
Sandra Earnest, CPC